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Table 1 Contraindications to in-home first-dose observation and to fingolimod in general

From: Analysis of cardiac monitoring and safety data in patients initiating fingolimod treatment in the home or in clinic

In-home first-dose observation contraindications

Factors that contraindicate in-home fingolimod initiation, owing to the need for overnight electrocardiogram monitoring in a medical facility

Patients who poorly tolerate bradycardia or may experience serious heart rhythm disturbances, including those with:

 ischemic heart disease

 history of myocardial infarction

 congestive heart failure

 history of cardiac arrest

 cerebrovascular disease

 uncontrolled hypertension

 history of symptomatic bradycardia

 history of recurrent syncope

 severe untreated sleep apnea

 atrioventricular block

 sinoatrial heart block

General contraindications

Factors that contraindicate treatment with fingolimod

Patients who in the preceding 6 months have experienced:

 myocardial infarction

 unstable angina

 stroke

 transient ischemic attack

 decompensated heart failure requiring hospitalization

 Class III/IV heart failure

Patients with a history or presence of:

 Mobitz type II second- or third-degree atrioventricular block

 sick sinus syndrome (unless the patient has a pacemaker)

 a baseline corrected QT interval ≥ 500 ms

Patients with cardiac arrhythmias requiring anti-arrhythmic treatment with Class Ia or class III anti-arrhythmic drugs (see Table 2)

Patients who have experienced a hypersensitivity reaction to fingolimod (or its excipients) including rash, urticaria, or angioedema